[Clinical experience on the management of post-traumatic bone defects of long bones treated with the membrane induction technique]

INTRODUCTION

bone defects drastically alter the patient's quality of life, and can produce serious sequelae such as dysfunctional shortening, angular deformity, joint stiffness and irreversible gait disorder.

OBJECTIVE

to describe the experience of managing post-traumatic bone defects of long bones treated with the membrane induction technique.

MATERIAL AND METHODS

retrospective observational study of patients with bone defects greater than 3 cm in diaphyseal pseudoarthrosis of long bones, who underwent the Masquelet technique. Period taken from January 2019 to January 2021. All patients underwent vigorous debridement and stabilization of the fracture, to then place the cement spacer. Spacer removal was at 4-6 weeks. The degree of consolidation was assessed, as well as the evolution of the treatment.

RESULT

25 patients were included in the study; the mean age was 36.8 ± 8.9 years. Diameter of bone losses was 3 to 10 cm (84%) and > 10 cm (16%). Bone consolidation occurred in patients with a defect < 10 cm (16%). 32% of patients presented some complication.

CONCLUSIONS

bone union was achieved only in a few patients with defects smaller than 10 cm, requiring alternative procedures in most cases. Proper selection of patients is required.

Exposición a radiación ionizante en médicos residentes de ortopedia en un hospital de referencia

OBJECTIVE

To describe and analyze the exposure to ionizing radiation of orthopedic residents.

METHOD

A prospective study was carried out to evaluate the degree of exposure to ionizing radiation with a bandage dosimeter placed under the lead apron for medical residents for 10 months. An online survey measured the degree of knowledge about radiation safety.

RESULTS

54 resident physicians participated. 55.6% report having knowledge of the existence of radiological protection equipment and 40.7% report that they had previous training in its use. 77.8% use the leaded apron and 31.5% use thyroid protection. 81.5% were positioned less than 1 meter from the source of the X-ray production of the arc in C. The total mean radiation exposure was 2.9 ± 2.17 mSv (95% confidence interval: 1.25-14.28; p = 0.424).

CONCLUSIONS

Orthopedic residents present radiation doses below the International Commission on Radiological Protection recommended limit. However, there is a lack of knowledge of radiation protection and as well as a lack of interest and ignorance of the adverse effects of radiation.

Timely radiographic detection of developmental dysplasia of the hip in family medicine residents. Educative intervention

BACKGROUND

Developmental dysplasia of the hip (DDH) is a complex clinical entity that is usually underdiagnosed, if not detected and managed early, will turn the affected individual into a disabled being, with negative social, economic and emotional effects.

OBJECTIVE

To determine the capacity for the timely radiographic detection of DDH before and after an educational intervention.

METHOD

An educational intervention is carried out in family medicine resident, where they are given training on detection in DDH radiographic projections. Pre- and post-training evaluation is carried out. Statistical analysis is performed using Student's t and χ2, taking p ≤ 0.05 as significant.

RESULTS

94 residents participated. In the pre-intervention evaluation, 87.2% had no knowledge of the early detection protocol (p = 0.525). It was observed that 98.9% incorrectly drew the Perkins line (p = 0.427), 96.8% the Hilgenreiner line (p = 0.177) and 87.2% did not consider the data of bilateral dysplasia (p = 0.956). After the educational intervention, 87.2% correctly drew the Perkins line (p = 0.926), 97.8% the Hilgenreiner line (p = 0.325) and 78.7% if they considered the data of bilateral dysplasia (p = 0.826).

CONCLUSIONS

After this training, 80% of family medicine residents were able to detect DDH in a timely manner.

Epidemiological profile of mandibular fractures in an emergency department

OBJECTIVE

To identify the epidemiological profile of mandibular fractures in the emergency department.

METHOD

Observational, retrospective study included records of persons with a diagnosis of mandibular fracture treated between January 1, 2015 and June 30, 2019, from the emergency department of the Hospital de Traumatología Dr. Victorio de la Fuente Narváez. The age, sex, occupation, comorbidities, prevalence of mandibular fractures according to the number of fractures and anatomical area, were obtained from the clinical records.

RESULTS

319 subjects with mandibular fractures were included in the study, which were young people (32.5 years) of the male sex (89.7%), the majority developed some trade (64.2%), 14.4% had some comorbidity, 76% had alcoholism when time of injury. The most affected anatomical site was the mandibular angle followed by the parasymphysis, the most frequent cause of injury was due to physical aggression.

CONCLUSIONS

Mandibular fractures in our emergency department are usually simple, mainly affecting the angle of the jaw, occurring mainly in men in their third decade of life, assaults are the most frequent injury mechanism and are generally associated with substance use toxic.

Association of depression and functional outcomes in patients treated surgically for cervical spondylotic myelopathy through an anterior approach

OBJECTIVE

To determine the association of Depression with clinical outcomes in patients treated surgically for cervical spondylotic myelopathy (CSM) using an anterior approach.

METHOD

An observational study was conducted in patients with ECM. The Beck scale, modified scale of the Japanese Orthopedic Association (mJOA), neck disability index (NDI) and the Visual Analogue Scale (VAS) were used preoperatively, one month and 3 months after surgery.

RESULTS

Initial VAS showed more severe degrees in patients with depression. At one month and third month after surgery, there was a significant decrease in pain in the group without depression (p = 0.03). The mJOA at one month and three months was observed that the degree of severity decreased in both groups, being more noticeable in the group without depression (p = 0.02). Presurgical NDI was higher in the group with depression. At three months in both groups the improvement was noticeable with respect to the degree of preoperative disability.

CONCLUSIONS

There is a favorable relationship in patients with ECM undergoing surgical treatment in the absence of depression prior to surgery and clinical evolution, with the possibility of promoting multidisciplinary management prior to surgery in patients with depression.

[Inter-observer agreement in the Paprosky classification in a hospital in a country of an emerging economy]

INTRODUCTION

The evaluation and management of acetabular bone loss in total hip arthroplasty is a challenge for orthopedic surgeons, we wish in this study to determine the inter-observer concordance in the Paprosky classification for acetabular defects.

MATERIAL AND METHODS

Observational, descriptive, longitudinal, prospective study. It was performed using anteroposterior hip radiographs of patients scheduled for primary total hip arthroplasty or revision with acetabular bone defect, Sinapse local X-ray system, 20 X-rays were assessed per observer taken randomly (doctors assigned to the joint replacement service with minimum experience of five years) using the Paprosky classification spontaneously, (without previous classes) for acetabular defects, inter-observer concordance was assessed using Cohen's Kappa coefficient.

RESULTS

An interobserver agreement was obtained on average for the Paprosky classification of acetabular defects using the Cohen's Kappa coefficient, the concordance analysis was done using the statistical program statistical package for the social sciences of 0.237.

CONCLUSIONS

Both the null hypothesis (Kappa greater than 0.80 value considered optimal) and the alternative hypothesis (Kappa from 0.41 to 0.80 value equal to moderate to good) did not agree with our study (Kappa equal to 0.237) value equal to mild, in addition , it was shown that the greater the acetabular defect, the lower the interobserver agreement in surgeons in our institution.

COST-EFFECTIVENESS OF VANCOMYCIN POWDER FOR DEEP WOUND INFECTION PROPHYLAXIS IN SPINE FUSION

ABSTRACT Objective: To identify the cost effectiveness of vancomycin powder in the prophylaxis of posterior lumbar spine instrumentation, seeking potential savings. Methods: A retrospective, observational study was performed to evaluate the cost effectiveness. Data were retrieved from patients’ files from March 2016 to April 2017; costs were considered for the procedures, as well as which antibiotic was used. Results: A total of 184 patients were included. Of these, 102 received prophylactic treatment with 1g of cephalothin and 82 received 1g of cephalothin and 1g of vancomycin powder, which was applied to the wound prior to tissue closure. Of the 184 patients, 110 were women (59%) and 74 were men (41%), and the mean age was 55 years (24-77). The participants had a median BMI of 28.9 kg/m2 (19-39). The average cost per hospitalized patient was $3974 USD and the average cost of rehospitalization due to infection was, on average, $7700 USD. The use of vancomycin powder led to cost savings of $75,008.79 USD per 100 posterior spinal fusions performed for degenerative spine. Conclusion: The use of vancomycin powder is a cost-effective option for prophylaxis of surgical site infection in spine fusion. Level of evidence III; Economic and decision analysis.

[Preventive analgesia in patients undergoing open surgery for rotator cuff repair]

INTRODUCTION

Preventive analgesia in orthopedic surgery is becoming increasingly important because post-surgical pain management is more pleasant for the patient and allows them to initiate rehabilitation early. With this premise we consider the following hypothesis. The perception of post-surgical pain at two, 12 and 24 hours with local infiltration into the surgical wound with ropivacaine plus systemic analgesia will be less compared to patients who infiltrate with saline into the surgical wound plus systemic analgesia.

MATERIAL AND METHODS

A randomized double-blind, prospective randomized controlled clinical trial was conducted in the period January 2018 to August 2018.

RESULTS

The null hypothesis is rejected in the group valued at two hours and the null hypothesis is accepted in the groups valued at 12 and 24 hours.

CONCLUSION

Ropivacaine infiltration is an effective method for managing postoperative pain for the first 2 hours in open shoulder surgery procedures.

Metabolic profiling of serum in patients with cartilage tumours using 1 H-NMR spectroscopy: A pilot study

Cartilage-forming lesions include tumours that can vary in severity from benign enchondromas to high-grade malignant chondrosarcomas. Chondrosarcoma is the second most frequent malignant bone tumour, accounting for 20-30% of all malignant bone neoplasms. Surgery is the standard treatment for cartilage tumours (CTs); however, their incidental diagnosis and the difficult differentiation of low-grade lesions like chondrosarcoma grade I from benign entities like enchondroma are challenges for clinical management. In this sense, the search for circulating biomarkers for early detection and prognosis is an ongoing interest. Targeted metabolomics is a powerful tool that can propose potential biomarkers in biological fluids as well as help to discover disturbed metabolic pathways to reveal tumour pathogenesis. In this context, the aim of this study was to investigate the ¹ H nuclear magnetic resonance metabolomic serum profile of patients with CTs contrasted with healthy controls. Forty-one metabolites were identified and quantified; the multivariate statistical methods principal component analysis and partial least squares discriminant analysis reveal a clear separation of the CT group, that is, the differential metabolites that were involved in two main metabolic pathways: the taurine and hypotaurine metabolism and synthesis and degradation of ketone bodies. Our results represent preliminary work for emergent serum-based diagnostics or prognostic methods for patients with chondrogenic tumours.

[Evaluation of the educational intervention in orthopaedic and traumatology residents for the taking, measurement and preparations of the hamstring graft]

INTRODUCTION

The education process is understood as an activity focused on developing competencies through the use of educational tools and strategies that can be evaluated. The training of the residents in traumatology and orthopedics requires you to acquire knowledge and develop skills that will affect the diagnosis, treatment and prognosis of the patient. Therefore, what will be the evaluation of the educational intervention on the theoretical and practical knowledge in this group of physicians on the technique of taking, measuring and preparation of hamstring graft for the reconstruction of anterior cruciate ligament?

MATERIAL Y METHODS

A prospective, quasi-experimental study was conducted to evaluate the impact of educational intervention in 23 Traumatology and orthopaedic residents on the use of hamstring in the anterior cruciate ligament reconstruction through theoretical sessions and Practice on cadaverous knees with preand post-intervention evaluations.

RESULTS

The correlation between the pre and post evaluation educational intervention, both theoretical and practical, was statistically significant (p = 0.004 and p = 0.4, respectively).

CONCLUSION

The statistically significant correlation between preand post-educational intervention evaluations speaks of the value of learning strategies, in the case of this study, the intervention through a theoretical and practical session by a simulated patient promotes knowledge acquisition and development of skills.